Provider Enrollment Application Fee

Certain providers enrolling in the Indiana Health Coverage
Programs (IHCP) are subject to an application fee. The IHCP Provider Enrollment Risk Category
and Application Fee Matrix provides a full list
of provider types and indicates which types are subject to
application fees. Generally, the application fee applies to
"institutional" providers, as defined by the Centers for Medicare
& Medicaid Services (CMS), and not to individual professionals,
such as physicians.

If providers are subject to an application fee, it is assessed
in full for each service location at initial
enrollment, revalidation, or with a
change of ownership. The application fee is NOT an
annual assessment.

Note

The application fee does not apply to practitioners enrolling
only as ordering, prescribing, or referring (OPR) providers.

If a provider's service location is enrolled in Medicare or the
provider pays an application fee to another state's Medicaid agency
for a specific service location, the provider is not required to
pay an application fee for that service location to the IHCP.

CMS sets the application fee amount, which may be adjusted
annually. The application fee for enrollments received in 2017 is
set at $560. The application fee for enrollments received in 2018
is set at $569.

Payment Options

The application fee can be paid only using one of the following
electronic methods. Paper forms of payment are not accepted.

Online - Go to the IHCP Bill
Pay site and follow the on-screen instructions. You can pay
online using a credit card, debit card, or electronic funds
transfer from your checking account. When the transaction is
complete, you will receive a confirmation number to enter in the
appropriate section of your IHCP provider packet.

By telephone - Contact IHCP Customer Assistance toll-free at
1-800-457-4584 and select the appropriate option. Please have your
credit card, debit card, or checking account information ready.
When the transaction is complete, you will receive a confirmation
number to enter in the appropriate section of your IHCP provider
packet.

Providers can download a Federal
W-9 form for reporting payments on the provider's tax
forms.